083 THE MANAGEMENT OF INFANTS UNDER 3MONTHS OF AGE WITH CONCOMITANT INDIRECT INGUINAL HERNIA AND IPSILATERAL PALPABLE UNDESCENDED TESTIS 1 2 1 3 1 Naomi Wright , Joseph Davidson , Christina Major , Nigel Hall , Nordeen Bouhadiba 1 2 Evelina Children´s Hospital, London, UK, University Hospital Lewisham, London, UK, 3 Faculty of Medicine, University of Southampton, Southampton, UK Background: There is scarce literature and no current guidelines regarding the management of boys under 3 months with concomitant indirect inguinal hernia (IIH) and ipsilateral palpable undescended testis (IPUDT). These pathologies coincide in approximately 1% of inguinal hernias in children. Aim: To undertake a national UK survey to define surgeons’ current practice in this patient population. Methods: A 10-question survey was administered to all UK based surgeons on the British Association of Paediatric Surgeons register (N=100). Results: Seventy-four consultants responded: 62 paediatric surgeons, 12 paediatric urologists. Of these, 82% (n=61) routinely perform open herniotomy in this population whereas 18% (n=13) perform laparoscopic hernia repair. In the absence of clinical evidence of IIH, 4% (n=3) undertake orchidopexy for UDT at 3-6months, 62% (n=46) at 612months and 34% (n=25) >12 months of age. In boys <3 months with both reducible IIH and IPUDT, 54% (n=40) would proceed to herniotomy and orchidopexy at this age, 23% (n=17) would undertake herniotomy at present and delay orchidopexy until >3 months of age and 8% (n=6) would delay both until >3months. Fifteen percent (n=11) would vary management depending on clinical and operative findings. Of those who would proceed with IIH repair <3 months, choice of operative procedure varied widely (Figure 1). The most common was open herniotomy and standard orchidopexy (45%, N=30). If the hernia was difficult to reduce, fewer surgeons would undertake concurrent orchidopexy (37%, n=25) and even less in the presence of an obstructed hernia (24%, n=16). The proportion undertaking laparoscopic hernia repair and future orchidopexy was similar in all 3 scenarios, 15-18%. Conclusion: There is a wide variety of practice across the country in managing this patient population, which reflects the lack of evidence supporting best practice. Multicentre prospective data are required to determine the optimum treatment pathway.
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